Most Common Discomfort about Rotator Cuff - How to Diagnose, Treat, or Prevent Injuries


What is rotator cuff?

What are the symptoms of a rotator cuff injury?

What are the types of rotator cuff injuries?

How do you diagnose a rotator cuff injury?

What are the risk factors for developing a rotator cuff injury?

How should I treat my rotator cuff injury?

What types of surgery are available to repair a rotator cuff injury?

How long does a rotator cuff injury take to heal?

How can I prevent a rotator cuff injury?

What is the rotator cuff?

The rotator cuff is a group of four muscles and their tendons that work together to stabilize the shoulder joint. These muscles include the supraspinatus, infraspinatus, teres minor, and subscapularis. They attach to the scapula (shoulder blade) and surround the head of the humerus (upper arm bone), forming a cuff-like structure. The main function of the rotator cuff is to help lift and rotate the arm, as well as maintain stability in the shoulder joint during movement. It also plays a crucial role in preventing injury by keeping the humeral head centered within the glenoid cavity of the scapula.

Rotator cuff tear symptoms, treatment, injury prevention

What are the symptoms of a rotator cuff injury?

Rotator cuff tear symptoms, treatment, injury prevention

Symptoms of a rotator cuff injury can vary depending on the severity of the injury, but common symptoms include pain and weakness in the shoulder, difficulty or inability to raise the arm overhead, popping or crackling sounds when moving the shoulder, and limited range of motion. Some people may also experience swelling, bruising, or tenderness around the shoulder. In more severe cases, there may be a noticeable deformity or change in the shape of the shoulder.

What are the types of rotator cuff injuries?

There are three main types of rotator cuff injuries: tendinitis, bursitis, and tears. Tendinitis is when the tendons in the rotator cuff become inflamed or irritated. Bursitis is when the bursa (fluid-filled sac) in the shoulder becomes inflamed. Tears can occur in one or more of the tendons in the rotator cuff and can range from minor partial tears to complete tears requiring surgery. Other less common types of rotator cuff injuries include impingement syndrome, calcific tendonitis, and adhesive capsulitis (frozen shoulder).

How do you diagnose a rotator cuff injury?

To diagnose a rotator cuff injury, doctors typically perform three tests: the active painful arc test, drop arm test, and weakness in external rotation.

Active painful arc test: Used to assess for any pain or discomfort while actively raising the affected arm. The patient will be asked to slowly raise their arm from their side up to shoulder level while keeping their elbow straight. If there is pain around the area of the shoulder joint between 60-120 degrees of elevation, it could indicate a rotator cuff injury.

The drop arm test: Evaluates for a tear in one of the rotator cuff tendons. In this test, the patient is asked to actively raise their arm out to the side and then slowly lower it back down. If they are unable to control the descent of their arm and it drops uncontrollably after reaching a certain point, it could suggest a torn rotator cuff tendon.

Weakness in external rotation: Helps identify which specific rotator cuff tendon may be injured. The doctor will ask the patient to stand with their arms at their sides and elbows bent at 90 degrees. They will then be instructed to rotate their arms outward against resistance from the doctor's hand. Weakness or pain during this movement can indicate an injured supraspinatus or infraspinatus tendon.

It is important to note that these tests alone cannot definitively diagnose a rotator cuff injury. Further imaging tests such as X-rays or an MRI may be needed for confirmation. Additionally, other factors such as medical history and physical examination may also play a role in properly diagnosing a rotator cuff injury.

What are the risk factors for developing a rotator cuff injury?

Some common risk factors for a rotator cuff injury include:

Age: As we get older, our muscles and tendons tend to weaken, making them more prone to injuries.

Overuse or repetitive movements: People who have jobs or participate in sports that require repetitive use of the shoulder joint are at a higher risk for developing a rotator cuff injury.

Poor posture: Slouching or having poor posture can lead to imbalances in the muscles surrounding the shoulder, which can increase the risk of a rotator cuff injury.

Weak muscles: If the muscles surrounding the shoulder joint are weak, they may not be able to support and stabilize it properly, leaving it vulnerable to injury.

Previous shoulder injuries: A previous shoulder injury or surgery can weaken the structures of the shoulder and make it more susceptible to a rotator cuff injury.

Genetics: Some people may have inherited traits that make them more likely to develop a rotator cuff injury, such as having smaller than average shoulders or being naturally more flexible in their joints.

Smoking: Smoking has been linked to decreased blood flow and healing abilities, which can increase the risk of injuries like rotator cuff tears.

Poor conditioning: Individuals who do not regularly engage in physical activity or who have poor overall physical conditioning may have weaker muscles and be at an increased risk for rotator cuff injuries.

Improper technique during exercise or lifting weights: Using incorrect form while exercising or lifting weights can put excessive strain on the shoulder joint and increase the risk of an injury.

Certain sports/activities: Sports that involve overhead motions, such as tennis, baseball, swimming, and weightlifting, put a significant amount of stress on the shoulders and increase the likelihood of developing a rotator cuff injury.

How should I treat my rotator cuff injury?

Treatment for a rotator cuff injury may vary depending on the severity of the injury. However, generally, the following steps can help in treating a rotator cuff injury:

Rest: The first step in treating a rotator cuff injury is to give it enough rest. Avoid any activities that cause pain or discomfort.

Ice therapy: Applying ice to the affected area can help reduce swelling and pain. Place an ice pack on the injured shoulder for 15-20 minutes, several times a day.

Pain medication: Over-the-counter pain medications such as ibuprofen or acetaminophen can help relieve pain and inflammation.

Physical therapy: A physical therapist can design an exercise program that will help strengthen the muscles surrounding the injured rotator cuff.

Heat therapy: After a few days of using ice therapy, heat therapy can be used to relax muscles and improve blood flow to the injured area.

Corticosteroid injections: In some cases, your doctor may recommend corticosteroid injections to reduce inflammation and pain in the shoulder.

Surgery: If conservative treatment does not improve symptoms or if there is a complete tear in the rotator cuff, surgery may be necessary to repair the tear.

It is important to consult with a doctor for a proper diagnosis and treatment plan for a rotator cuff injury. Ignoring or mistreating this type of injury could lead to further damage and complications in the future.

What types of surgery are available to repair a rotator cuff injury?

There are several types of surgery that can be performed to repair a rotator cuff injury, depending on the severity and location of the injury. These include:

Arthroscopic Repair: This is a minimally invasive procedure where a small camera (arthroscope) and specialized instruments are used to repair the damaged tendon. It involves making small incisions and using tiny anchors to reattach the tendon to the bone.

Open Repair: In this procedure, a larger incision is made in the shoulder to access and repair the torn tendon. This option is usually recommended for larger or more complex tears.

Mini-Open Repair: This technique combines aspects of both arthroscopic and open repair, using a smaller incision than open surgery but still allowing for better visualization of the damaged tissue than arthroscopy alone.

Tendon Transfer: If the rotator cuff tendon cannot be repaired, a nearby tendon may be used as a replacement. This is known as a tendon transfer, and it can help restore stability and function to the shoulder.

Shoulder Replacement: In severe cases where there is extensive damage to the rotator cuff, a shoulder replacement may be necessary. This involves replacing the damaged parts of the shoulder joint with artificial components.

How long does a rotator cuff injury take to heal?

The healing time for a rotator cuff injury can vary depending on the severity of the injury and the individual's overall health. In general, it can take anywhere from several weeks to several months for a rotator cuff injury to heal completely. However, it is important to note that proper treatment and rehabilitation are crucial in promoting healing and preventing further damage.

For minor rotator cuff injuries, such as mild strains or tears, rest and physical therapy exercises may be enough to promote healing within 4-6 weeks. In more severe cases, surgery may be required to repair the damaged tissues. Recovery from surgery can take up to 6 months or longer.

It is important to follow your doctor's recommendations for treatment and rehabilitation in order to achieve optimal healing. Ignoring symptoms or attempting to return to regular activities too soon can prolong the healing process and increase the risk of re-injury.

How can I prevent a rotator cuff injury?

Rotator Cuff Anatomy

Strengthen your rotator cuff muscles: The best way to prevent a rotator cuff injury is to strengthen the muscles that support your shoulders. This can be achieved through targeted exercises such as shoulder rotations, external and internal rotations, and prone rows.

Warm-up before exercise: Before engaging in any physical activity, it is important to properly warm up your muscles. This helps to increase blood flow and prepare your muscles for the upcoming workout.

Use proper form: When performing any type of exercise or activity that involves your shoulders, make sure you are using proper form. Incorrect form can put unnecessary strain on your rotator cuff muscles and increase the risk of injury.

Avoid overuse: Rotator cuff injuries often occur due to overuse. Make sure to give your shoulders enough rest between workouts or activities that require repetitive shoulder movements.

Stretch regularly: Keeping your shoulders flexible is also important in preventing a rotator cuff injury. Incorporate stretching into your daily routine, especially after exercising.

Listen to your body: If you experience any pain or discomfort in your shoulder area, do not ignore it. Stop the activity and rest until the pain subsides. If the pain persists, consult a healthcare professional.

Adjust work ergonomics: If you have a job that requires repetitive arm movements (such as painting or construction work), make sure to adjust your work ergonomics to avoid putting strain on your rotator cuff muscles.

Stay hydrated: Drinking enough water is crucial for maintaining healthy muscles and joints. Make sure to stay hydrated throughout the day, especially during physical activity.

Avoid heavy lifting: Be cautious when lifting heavy objects, as this can put excessive strain on your shoulders and lead to a rotator cuff injury.

Seek medical attention if necessary: If you experience persistent pain or weakness in your shoulder area, seek medical attention from a healthcare professional. They can properly diagnose and treat any potential rotator cuff injuries.


About Marika Forsythe, MD

Dr. Forsythe graduated from the New York University medical school.  Currently, she is a medical resident in NJ.